Physician pain and discomfort during minimally invasive gynecologic cancer surgery

• A significant number of gynecologic oncologists experience adverse symptoms related to performing surgery.
• Independent risk factors for adverse physical symptoms were female gender and use of the robotic system.

ObjectiveDespite increasing awareness of physical strain to surgeons associated with minimally invasive surgery (MIS), its use continues to expand. We sought to gather information from gynecologic oncologists regarding physical discomfort due to MIS.MethodsAnonymous surveys were e-mailed to 1279 Society of Gynecologic Oncology (SGO) members. Physical symptoms (numbness, pain, stiffness, and fatigue) and surgical and demographic factors were assessed. Univariate and multivariate analyses were performed to determine risk factors for physical symptoms.ResultsWe analyzed responses of 350 SGO members who completed the survey and currently performed > 50% of procedures robotically (n = 122), laparoscopically (n = 67), or abdominally (n = 61). Sixty-one percent of members reported physical symptoms related to MIS. The rate of symptoms was higher in the robotic group (72%) than the laparoscopic (57%) or abdominal groups (49%) (p = 0.0052). Stiffness (p = 0.0373) and fatigue (p = 0.0125) were more common in the robotic group. Female sex (p < 0.0001), higher caseload (p = 0.0007), and academic practice (p = 0.0186) were associated with increased symptoms. On multivariate analysis, robotic surgery (odds ratio [OR] 2.38, 95% CI 1.20–4.69) and female sex (OR 4.20, 95% CI 2.13–8.29) were significant predictors of symptoms. There was no correlation between seeking treatment and surgical modality (laparotomy 11%, robotic 20%, laparoscopy 25%, p = 0.12).ConclusionsGynecologic oncologists report physical symptoms due to MIS at an alarming rate. Robotic surgery and female sex appear to be risk factors for physical discomfort. As we strive to improve patient outcomes and decrease patient morbidity with MIS, we must also work to improve the ergonomics of MIS for surgeons.